Defining Successful Program Configurations in Home-Based Primary Care

定义家庭初级保健的成功计划配置

基本信息

批准号：
10641551
负责人：
Samuel T Edwards
金额：
--
依托单位：
PORTLAND VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-01 至 2027-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10641551
关键词：
Address Adopted Behavioral Binding Sites Caregiver support Caregivers Caring Case Study Characteristics Chronic Chronic Disease Client satisfaction Clinical Cluster Analysis Complex Data Development Effectiveness Emergency Care Enrollment Future Geriatrics Goals Health Health Care Costs Home Home visitation Hospice Care Hospitalization Hospitals Individual Institution Institutionalization Intervention Interview Long-Term Care Mathematics Measures Medical Medicare Methodology Methods Mission Modeling Nurses Nursing Homes Outcome Outcome Measure Patient-Focused Outcomes Patients Pattern Patterns of Care Performance Population Primary Care Process Quality of life Recurrence Regression Analysis Research Risk Services Site Structure Testing Time Urbanicity Variant Veterans Visualization Work aging in place analytical method care delivery clinical care community based service comorbidity contextual factors cost demographics effectiveness/implementation trial end of life care flexibility high risk holistic approach improved innovation meetings member novel palliative patient home care patient oriented primary care clinician primary care patient primary care team programs social success theories

项目摘要

Background: Home-Based Primary Care (HBPC) is a unique home care program that provides comprehensive, longitudinal primary care to Veterans with complex chronic disease with an interdisciplinary team of VA staff. HBPC enrollment is associated with reduced hospitalizations, reduced health care costs, and high patient satisfaction, and is a critical component of the Office of Geriatrics and Extended Care’s (GEC’s) strategy to shift long term services and supports into home and community-based services. Significance: GEC plans to expand HBPC by 75 sites by 2026, but there is substantial variation in individual HBPC site structures, populations served, care delivery patterns, and clinical outcomes. It is unknown whether this variation represents variable fidelity to the HBPC clinical model and an opportunity to improve efficiency vs. appropriate flexibility and adaptation to varying patient needs and local contexts. Given planned expansion, a detailed understanding of program variation is needed to understand which configurations of program features are successful in what contexts and why. Innovation & Impact: This proposal uses configurational analysis, an emerging mixed-methods approach, to identify configurations of HBPC program and contextual characteristics associated with longer patient home time, a novel patient-centered outcome measure. Patient home time is a novel measure that captures a universal goal in HBPC, the time a Veteran can live independently at home. Results of this study will inform HBPC expansion and will help existing engage in context-tailored quality improvement efforts. Specific Aims: Aim 1: Assess variation among HBPC sites in contextual and modifiable factors, patient characteristics, and care delivery patterns, and identify site and patient level correlates of clinical outcomes. Aim 2: Assess HBPC team member and Veteran perspectives on potential mechanisms of success in sites that are high and low performing in patient home time. Aim 3: Identify factors that distinguish HBPC sites with higher versus lower performance in patient home time. Methodology: Aim 1 is a quantitative study in which we will build descriptive profiles of all 440 HBPC sites using VA and Medicare data and perform regression analysis and cluster analyses to examine site and patient level correlates of clinical outcomes. In Aim 2 we will perform qualitative interviews of HBPC clinicians, staff, and Veterans, and observation of work practices in 10 HBPC sites with high performance and 10 with low performance in patient home time. Aim 3 will use configurational analysis, a cross case analysis method rooted in mathematical set theory, to identify features identified in Aims 1 and 2 that are necessary and/or sufficient for longer patient home time. Next Steps/Implementation: We will work with partners in GEC to use identified configurations of HBPC site features to inform HBPC expansion, and to facilitate the development of a complexity informed, adaptive quality improvement intervention for use in existing HBPC sites.

背景：家庭初级护理 (HBPC) 是一项独特的家庭护理计划，提供为患有复杂慢性疾病的退伍军人提供跨学科的全面、纵向初级保健 VA 工作人员团队的加入与住院率的降低、医疗费用的降低以及患者满意度高，是老年病学和延伸护理办公室 (GEC) 的重要组成部分将长期服务和支持转变为家庭和社区服务的战略。启示：GEC 计划到 2026 年将 HBPC 扩展 75 个站点，但各个站点之间存在很大差异 HBPC 站点结构、服务人群、护理服务模式和临床结果尚不清楚。这种变化代表了 HBPC 临床模型的可变保真度以及提高效率的机会与适当的灵活性和适应不同患者需求和当地情况的考虑。需要详细了解程序变化才能了解程序的哪些配置功能在什么情况下成功以及为什么成功。创新和影响：该提案使用配置分析（一种新兴的混合方法）来确定 HBPC 计划的配置以及与较长患者居家相关的背景特征时间，一种新颖的以患者为中心的结果衡量标准患者在家时间是一种捕捉患者在家时间的新颖衡量标准。 HBPC 的普遍目标是退伍军人可以在家独立生活的时间。这项研究的结果将告诉我们。 HBPC 的扩张将帮助现有企业参与针对具体情况的质量改进工作。具体目标：目标 1：评估 HBPC 站点之间在背景因素和可改变因素、患者等方面的差异特征和护理提供模式，并确定临床结果的地点和患者水平的相关性。目标 2：评估 HBPC 团队成员和退伍军人对现场成功的潜在机制的看法目标 3：确定区分 HBPC 站点的因素。患者在家时间表现较高与较低。方法：目标 1 是一项定量研究，我们将构建所有 440 个 HBPC 站点的描述性概况使用 VA 和 Medicare 数据并执行回归分析和聚类分析来检查地点和患者在目标 2 中，我们将对 HBPC 顾客、工作人员、和退伍军人，并对 10 个高性能 HBPC 站点和 10 个低性能站点的工作实践进行观察目标 3 将使用构型分析，这是一种基于跨案例分析的方法。在数学集合论中，识别目标 1 和 2 中确定的必要和/或充分的特征延长患者在家的时间。后续步骤/实施：我们将与 GEC 的合作伙伴合作，使用 HBPC 站点的已确定配置为 HBPC 扩展提供信息，并促进复杂性信息的自适应开发用于现有 HBPC 站点的质量改进干预措施。